Noble Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required Annual inspection at 10:00 a.m. The LPA met with Administrator Armine Tagaryan and explained the reason for the visit. The LPA, and the administrator toured the inside and outside of the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 75 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. One fire extinguisher was fully charged and was last serviced 08/30/2023. The LPA observed required postings throughout the common space. KITCHEN: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents, and two staff. The hot water temperature measured at 110.5 degrees Fahrenheit. BEDROOMS: Facility has four (4) bedrooms. One bedroom is shared, and three (3) bedrooms are private. Bedrooms were furnished appropriately with appropriate furnishings, bedding, and sufficient lighting. BATHROOMS: The facility has three (3) bathrooms. Two bathrooms are for residents, and one bathroom for staff, and visitors. The shower areas were in clean condition with grab bars and non-skid mats available. Soap, and paper towels were available for drying hands. Hand washing signs were displayed.The hot water temperature measured at 110.5 degrees Fahrenheit. Continues on LIC 809C... OUTDOOR SPACE: The LPA observed the backyard of the facility to be free of clutter and debris. Outdoor furniture and a shaded area are available for residents. There is a pool which is fenced in, and inaccessible from residents. RECORDS: Records review began at 11:45 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:30 p.m.; medications are centrally stored and locked in a file cabinet in the office area; medications are labeled and were checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 5, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required Annual visit at 11:00 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Armine Tagaryan, and explained the reason for the visit. INFECTION CONTROL: Upon entry, the facility has a sign in book and sanitizing gel. Infection Control signage was visible at entrance. Temperature was taken by administrator, and the LPA was asked to sign in. Staff were wearing masks. The LPA, and the administrator toured the inside and outside of the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At 11:15 a.m., the LPA, and the administrator toured the living area and common area and found them to be appropriately furnished and in good condition. Kitchen: At 11:20 a.m., the LPA observed the kitchen/dining area. Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents, and two staff. Continues on LIC 809C... Bedrooms: At 11:25 a.m., LPA inspected the residents’ bedrooms. Facility has four (4) bedrooms. Two bedrooms are shared, and two bedrooms are single occupancy. Bedrooms were furnished appropriately with appropriate furnishings, bedding, and sufficient lighting. Bathrooms: At 11:45 a.m., the LPA inspected the residents’ bathrooms. The facility has three (3) bathrooms. Two are for residents, and one bathroom for caregivers, and visitors. The shower areas were in clean condition with grab bars and non-skid mats available. Soap, and paper towels were available for drying hands. Hand washing signs were displayed. Outdoor Space: At 12:25 pm, the LPA observed the backyard of the facility to be free of clutter and debris. There is a pool which is fenced in, and inaccessible from residents. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued.the state’s words, verbatim · CDSS document, Sep 8, 2022

Allegation investigated: Staff unable to communicate residents needs due to language barrier. Call button not accessible to resident. Staff does not follow food menu for residents. Staff does not provide nutritious meals for residents. Breakfast is not served in a timely manner.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the above allegations. The LPA arrived at the facility at 9:37 a.m. and met with administrator Armine Tagaryan. The LPA explained the reason for the visit. On 10/18/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegations. LPA Urena arrived at the facility at 2:05pm, and met with the Administrator Armine Tagaryan at 2:15pm and explained the purpose of the visit. At 2:30 pm, LPA Urena and the administrator conducted a brief tour of the facility, inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. Unsubstantiated Staff unable to communicate residents needs due to language barrier. It is alleged that there is a language barrier between facility staff, and residents, and that residents have a hard time asking for assistance. To investigate this allegation, the LPA interviewed residents, staff, and the Administrator. The interviews were conducted on 10/18/2021 between 2:45 p.m. and 3:30 p.m. The LPA interviewed the Reporting Party (RP) on 10/18/2021 at approximately 11:32 a.m. The interviews revealed that five out of five residents can communicate their needs to staff, and that staff understands the residents’ requests. The residents stated that the basic daily needs of the residents are understood by staff. The LPA interviewed the RP, and the RP stated that they were able to understand staff when they communicated at the facility, and added that R1 is hard of hearing which may contribute to the communication concern. The LPA attempted to interview R1, but R1 was unable to respond to the questions. The LPA interviewed staff at 3:05 p.m., and staff was able to comprehend, and answer the questions asked throughout the interview. The administrator stated that they are present during the day, and night at the facility to provide assistance with care. Based on the observations, and the information gathered through the interviews for the above allegation, there is insufficient evidence to support the claim that there is a language barrier, which causes staff to be unable to communicate residents' needs. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. Call button not accessible to resident. It is alleged that there is no call button accessible to call for assistance, and residents must yell out for assistance. To investigate this allegation, the LPA conducted residents’ and staff interviews on 10/18/2021, from 2:45 P.M. to 3:30 p.m. On 10/18/202, at 2:35 p.m., the LPA and the administrator conducted a tour of the facility’s bedrooms and observed that there was no signal system/device present in the bedrooms for residents to call for assistance. The residents' interviews revealed that residents call out to staff if in need of help, by calling out the name of the staff, and that the staff check on them throughout the day, when residents are in their room. Bedrooms doors are kept open throughout the day. Staff interviews revealed that staff check on residents every 10 to 15 minutes, when the residents are in their bedrooms. The LPA attempted to interview R1, however R1 was not responding to the questions. Staff interviews revealed that residents spend a portion of the day in the common area watching television, walking throughout the facility or sitting in the patio area. On 5/18/2022, at 3:25 p.m., the LPA interviewed the administrator about the call button or a signal system. The interview revealed that the administrator had used in the past, a battery operated signal system, however the signal system device used was too loud, and it was disturbing the rest of the residents, consequently the device was removed. Additionally, the administrator stated that they would be looking into a signal system device that will be less intrusive, and that will allow for residents to summon staff without disturbing the rest of the residents. Based on the observations, and the information gathered through the interviews for the above allegation, although there was no call button in place in each bedroom, there is insufficient evidence to support the claim that residents could not summon the assistance of staff. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. Staff does not follow food menu for residents. It alleged that staff do not follow the menu for residents. To investigate this allegation the LPA requested copies of sample menus and interviewed residents, staff and administrator. On 10/18/2021, the LPA reviewed sample menus and observed that the sample menus are posted in the kitchen area. The menus have a variety of foods listed for different days of the week. On 10/18/2021, at 2:45 p.m., the LPA interviewed residents about the menu of the facility. The residents’ interviews revealed that the residents are not aware of the menu. However the residents stated that they liked the food served to them, and that there was plenty of food served. The residents stated that they get soups, fresh fruits, snacks and vegetables. The LPA attempted to interview R1 about the menu, but R1 was unable to respond to the questions. The LPA and the administrator observed the refrigerator to have a two-day supply of perishable foods, vegetables and fresh fruits, bananas, apples and oranges. On 10/18/2021 the LPA interviewed the administrator about the menu and the meal items on the menu. The administrator stated that staff follows the menu as closely as possible, but sometimes may substitute the meal items within the same food grou Based on the observations, the information gathered through the record review, and interviews for the above allegation, there is insufficient evidence to support the claim that staff does not follow the menu. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. Staff does not provide nutritious meals for residents. It is alleged that staff does not provide nutritious meals, and that residents are not provided with meat, eggs, rice, vegetables, juice. To investigate this allegation, on 10/18/2021, the LPA conducted residents’, staff and administrator interviews from 2:45 p.m. to 3:30 p.m. At 2:45 p.m., the LPA interviewed residents about the meals served at the facility. The following is a summary of the meals served as described by residents, and is not verbatim: Pancakes, oatmeal, cake, apple, and banana slices, strawberries, chicken, coffee, chocolate milk, tea, eggs, cereal, rice, soups, hash brown, salads, sandwiches, and pizza. The LPA attempted to interview R1, but R1 was unable to respond to the questions. On 10/18/2021, at 3:05 p.m., the LPA interviewed the administrator about the meals and food served to residents. The administrator stated that the soups served are varied in content, and that the soups provide all the food components, because the soups contain meat, vegetables, and grains. The soups are easier for the residents to eat and digest. On 10/18/2021, and 05/18/2022 at 11:30 a.m., the LPA reviewed the sample menus which showed a variety of meals. The sample menus reviewed indicate that the menus meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. Based on the observations, the information gathered through the record review, and interviews for the above allegation, there is insufficient evidence to support the claim that staff does not provide nutritious meals for residents. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. Breakfast is not served in a timely manner. It is alleged that breakfast is not served in a timely manner, and that breakfast was not served till 9:00 a.m. To investigate this allegation, the LPA conducted record review, and interviews. On 10/28/2021, between 2:45 p.m. and 3:30p.m., the LPA interviewed residents, staff and administrator about the meals served throughout the day. At 2:45 p.m.,the residents’ interviews revealed that they get breakfast in the morning, but could not tell the LPA the exact time. The residents stated that it was served in the ‘morning’. The LPA attempted to interview R1, but R1 was unable to respond to the questions. At 3:05 p.m., the LPA interviewed staff about breakfast time, and staff indicated that they start serving breakfast at 8:00 a.m., but sometimes the residents are not yet awake, and they may wait a bit longer to start getting them ready for breakfast. However, breakfast is ready by 8:00 a.m. On 5/18/2022, at 2:30 p.m., the LPA interviewed the administrator, and the administrator stated that staff have breakfast ready by 8:00 a.m., but wait for residents to wake up, if residents don't wake up, then staff starts to get residents cleaned and ready for breakfast. On 10/18/2021, and 05/18/2022, the LPA reviewed the posted menus. The menus are posted in the kitchen area. The menus have the times when the meals are served. Breakfast is served between 8:00 a.m to 8:30 a.m., lunch between 12:00 p.m., to 12:30 p.m.,and dinner between 5:30 p.m and 6:00 p.m. Two snacks are provided between meals. The investigation revealed that no more than fifteen (15) hours elapse between the third and the first meal of the day. Based on the observations, the information gathered through the record review, and interviews for the above allegation, there is insufficient evidence to support the claim that breakfast is not served in a timely manner. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. No citations were issued. Exit interview was conducted with the administrator. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 18, 2022 · control 29-AS-20211014122432

Allegation investigated: Staff not providing assistance to resident(s) in a timely manner.

On 10/18/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegation. LPA Urena arrived at the facility at 2:05pm, and met with the Administrator Armine Tagaryan at 2:15pm and explained the purpose of the visit. At 2:30 pm, LPA Urena and the administrator conducted a tour of the facility, inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The indoor and outdoor of the facility was found to be in working condition. Four out of four bedrooms had adequate furnishings, bedding, personal space and lighting. Two out of two bathrooms were found in clean condition with paper towels for hand drying and signs for washing hands. Kitchen was found to be in clean condition, knives were propertly locked. There was perishable and non perishable food available for six residents and three staff. Continues on LIC 9099-C... Unsubstantiated During the tour of the facility the LPA and Administrator observed residents ask for assistance and caregivers attended promptly to their call. LPA Urena interviewed five out of five residents from 2:45pm to 3:30pm about staff assisting residents in the facility in a timely manner. Interviews revealed that five out of five residents confirmed S3 is providing care and supervision to the residents in a timely manner (at night). Residents stated that when they need assistance they call out for assistance, and staff come to attend their needs. Bedroom doors are kept open at all times of the day and night. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Exit interview conducted, today's report was reviewed with administrator. Signatures were obtained, report was issued.the state’s words, verbatim · CDSS document, Oct 18, 2021 · control 29-AS-20211014122432

Type of visit: Required - 1 Year

At 1:25 pm, Licensing Program Analyst (LPA) Sandra Urena arrived at facility, to conduct an unannounced required annual inspection visit. The LPA introduced herself to administrator Armine Tagaryan and explained the reason for the visit. INFECTION CONTROL: Upon entry, the facility has a sign in book and sanitizing gel. Infection Control signage was visible at entrance. Temperature was taken by caregiver and the LPA was asked to sign in. The LPA toured the inside and outside of the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At 1:45pm, the LPA toured the living area and common area and found them to be appropriately furnished and in good condition. Kitchen: At 1:50 pm, the LPA observed the kitchen/dining area. Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents and two staff. Bedrooms: At 2:15 pm, LPA inspected the residents’ bedrooms. Facility has four (4) bedrooms. Two bedrooms are shared, and two bedrooms are single occupancy. Bedrooms were furnished appropriately with appropriate furnishings, bedding, and sufficient lighting. Bathrooms: At 2:30 pm, LPA inspected the residents’ bathrooms. The facility has three (3) bathrooms. Two are for residents, and one bathroom for caregivers and visitors. The shower areas were in clean condition with grab bars and non-skid mats available. Soap, and paper towels were available for drying hands. Hand washing signs were displayed. Outdoor Space: At 2:45 pm, the LPA observed the backyard of the facility to be free of clutter and debris. There is a pool which is fenced in and inaccessible from residents. Facility Records: At 3:00 pm, the LPA observed records for residents and staff to be complete and accurate at the time of this visit. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued.the state’s words, verbatim · CDSS document, Sep 24, 2021